Gamma variant vertically transmitted from a mild symptomatic pregnant woman associated with fatal neonatal COVID

Gonçalves-Ferri, Walusa Assad; Carvalheiro, Cristina Galdonyi; Mussi-Pinhata, Marisa Marcia; Cavasin, Bruna Pinto Dias; Fonseca, Benedito Antonio Lopes da

doi:10.1016/j.bjid.2022.102385

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Case Report • Braz J Infect Dis 26 (4) • 2022 • https://doi.org/10.1016/j.bjid.2022.102385 copy

Gamma variant vertically transmitted from a mild symptomatic pregnant woman associated with fatal neonatal COVID

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Herein we describe a mild symptomatic real-time reverse transcriptase- polymerase chain reaction-confirmed coronavirus 2 (SARS-CoV-2) infection in a pregnant woman who gave birth to a preterm infant, 32 weeks gestational age. The neonate was immediately isolated after delivery and developed severe respiratory disease that progressed to multisystem inflammatory syndrome and death on the seventh day of life.

Genome sequencing detected the P.1 (gamma) variant in samples obtained at hospital admission (mother) and on the first (10h) and 13th days of life (neonate). Complete homology (mother’s and newborn’s sequences) confirmed vertical transmission.

To our knowledge, this is the first report of vertically-transmitted SARS-CoV-2 P.1 (gamma) variant in a mild symptomatic infection in pregnancy associated with fatal COVID in a neonate.

Keywords:
Sars-CoV-2 variant; Vertical transmission; Covid 19; Preterm infant

Clinical data	Maternal evolution						Neonatal evolution
Clinical data	31 weeks	31 weeks and 4 days	31 weeks And 6 days	32 weeks and 1 day	32 weeks and 3 days	3 days after delivery	1-21 Days	22 -29 days	30-36 days	37-74 days
Diagnosis	-	Premature rupture of membranes	-	Chorioamnio nitis	Spontane ous labor in breech presentati on.	-	Neonatal respiratory distress syndrome	Septic shock	MIS-C	Death
Clinical data	Ageusia and anosmia	Ageusia and anosmia	Ageusia and anosmia	Fever (38C), Ageusia and anosmia	Ageusia and anosmia	Ageusia and anosmia	Seizures Respiratory distress Shock; Cardiac arrest (10 min)	Pulmonar y hypertension. (PAP: 60 mmHg) Shock.	MISC-C Heart: Biventricular concentric hypertrophy; Shock.	MIS-C Persistent hypoxemia and pulmonary hypertension Acute myocardial infarction Cardiac failure
Laboratory findings	-	Positive SARS-CoV-2 RT-PCR	Syphilis, HIV, and toxoplasmosis serology screening and vaginal- rectal cultures for Group B Streptococcus obtained were negative. C-reactive protein levels and complete blood count were normal.	Left shift on CBC [6.1 × 103/mL leukocytes (2% promyelocytes, 1% myelocytes, 4.2% bands)] and a high CRP level [7.2 mg/dL (normal value<1.0)]			Ferritin: 821.90	Troponin e:1,175.00	Troponin e:15,780.10	Ferritin: 1515.6 NT-Pro-BNP (pg/mL)^* * Normal reference values: ferritin 22-322 ng/mL; NT-pro-BNP <125 pg/mL; PT 1.3 sec; troponin I <19 ng/dL. >35,000
Treatme nt		Hospitaliza tion	Two doses of betamethasone (6 mg/day) and enoxaparin (60 mg/day).	Clindamycin was initiated	Cesarean delivery	Discharge (domiciliary isolation)	Exogenous surfactant; Mechanical ventilation; Vasoactive drugs; Enoxaparin; Azithromycin; Hydrocorti sone	iNO; Vasoactive drugs;	iNO; Vasoactive drugs	iNO; Sildenafil; Bosentan; Exogenous surfactant; Metroprolol; Intravenous immunoglobuli n; High-dose pulse steroids (methylprednisolone)

Author/Year	Country	HOL (h)	GA (weeks)	Clinical signs	Outcome	Variant
Zamaniyan et al.²¹21 Zamaniyan M, Ebadi A, Aghajanpoor S, Rahmani Z, Haghshenas M, Azizi S. Preterm delivery, maternal death, and vertical transmission in a pregnant woman with COVID-19 infection. PrenatDiagn. 2020;40:1759–61. 2020	Iran	1	32	Fever	Not discharge at the publication time, but well	-
Kulkarni et al.²²22 Kulkarni R, Rajput U, Dawre R, et al. Early-onset symptomatic neonatal COVID‑19 infection with high probability of vertical transmission. Infection. 2021;49:339–43. 2021	India	38	38,2	Fever, poor feeding, and hyperbilirubenemia	Discharge at 21 DOL	-
Verheijen et al.²³23 Verheijen AC, Janssen EER, van der Putten ME, et al. Management of severe neonatal respiratory distress due to vertical transmission of severe acute respiratory syndrome coronavirus 2: a case report. J Med Case Rep. 2022;16:140. 2022	Netherlands	19	36,7	Respitarory distress; MV for 22 days	Discharge/resolution	B.1.177
Alzamora et al.²⁴24 Alzamora MC, Paredes T, Caceres D, et al. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol. 2020;37:861–5. 2022	Peru	16		Respiratory distress	Discharge/ resolution	-
Morales,²⁵25 Morales HSG, Cortes DV, Hernandez HS, et al. Vertical transmission: evidence of COVID-19 in a twin pregnancy. JBRA Assist Reprod. 2022;26:153–7. 2022	Spain		31,6	Respiratory distress, 12h of MV, tachycardia and myocarditis	Discharge/resolution	-
Kalani-moghaddam et al.²⁶26 Kalani-Moghaddam F, Pouralizadeh N, Pourdowlat G, et al. The youngest surviving COVID-19 patient: a case report. Int J Surg Case Rep. 2022;94:107065. 2022	Iran	1	39,4	Respiratory distress, MV for 4 days, hemodynamic instability	Discharge at 20 DOL	-
Malek et al.²⁷27 Malek A, Khadga M, Zahid N, et al. Multisystem inflammatory syndrome of a neonate from a COVID-19-infected mother: a case report. Cureus. 2022;14:e23046. 2022	Indian	2	27	Respiratory distress (CPAP), MISC	Discharge at 24 DOL	-
Sanches et al.²⁸ 2022	USA		30	Pneumonia, MV for 12 days	Death at 12 DOL	-
Gonçalves-Ferri et al. 2022	Brazil	7	32	Respiratory distress, MISC, MV for 74 days	Death at 74 DOL	P.1

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[1] * Corresponding author at: Department of Pediatrics, Ribeirão Preto Medical School– University of Sao Paulo, Avenida Bandeirantes, 3900,14090-000 Ribeirão Preto- SP, Brazil. E-mail address: walusa@fmrp.usp.br (W.A. Goncalves-Ferri).